§ 9789.12.11 Evaluation and Management: Coding - New Patient; Documentation

Summary

A guide to billing for evaluation and management (E/M) services for new patients, complete with links to the necessary regulatory information and detailed instructions

In section 9789.12.11, the California Division of Workers’ Compensation (DWC) separately defines and distinguishes:

  • new patients, and
  • established patients.

New Vs. Established Patient

  1. A “new patient” is one who is new to the physician or medical group or an established patient with a new industrial injury or illness. Only one new patient visit is reimbursable  when billing for the same incident, injury or illness.
  2. An “established patient” is a patient who has been seen previously for the same incident, injury or illness.

Section 9789.12.11 also establishes the required guidelines for Evaluation & Management Services. For Evaluation & Management services, physicians and qualified non-physician practitioners must use either:

  • the “1995 Documentation Guidelines for Evaluation & Management Services,”
  • or “1997 Documentation Guidelines for Evaluation and Management Services.”

California Code of Regulations (CCR)

§ 9789.12.11 Evaluation and Management: Coding - New Patient; Documentation

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

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